Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9506 - MINNESOTACARE
Part 9506.0200 - PREPAID MINNESOTACARE PROGRAM; GENERAL
Universal Citation: MN Rules 9506.0200
Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1. Designation of geographic area.
The commissioner shall designate geographic areas in which enrollees must receive covered health services through a managed care health plan.
A. In designating geographic
areas, the commissioner shall consider area size, size of the population to be
served, accessibility of health services, the availability of health plans, and
any other factors necessary to provide the most economical care consistent with
high medical standards.
B. The
commissioner shall implement either a multiple health plan model or a single
health plan model in a designated geographic area.
(1) A multiple health plan model is a health
services delivery system in which more than one managed care health plan is
offered to enrollees in the geographic area.
(2) A single health plan model is a health
services delivery system in which only one health plan is available to
enrollees in the geographic area.
C. The commissioner may limit the number of
health plans with which the department contracts within a designated geographic
area, taking into consideration:
(1) the
number of enrollees within the designated geographic area;
(2) the number of potential health plan
contractors;
(3) the size of the
provider network offered by health plans;
(4) the health services offered by a health
plan;
(5) qualifications of health
plan personnel;
(6) accessibility
of services to enrollees;
(7)
health plan assurances of enrollee confidentiality;
(8) health plan marketing and enrollment
activities;
(9) health plan
compliance with parts
9506.0010 to
9506.0400;
(10) health plan performance under other
contracts with the department to serve MinnesotaCare enrollees and medical
assistance or general assistance medical care recipients; or
(11) any other factors necessary to provide
the most economical care consistent with high medical standards.
Subp. 2. Contracts.
Contracts between the department and a health plan to provide covered services to enrollees must:
A.
require the health plan to serve medical assistance recipients and general
assistance medical care recipients;
B. comply with the requirements of United
States Code, title 42, section 1396a(a)(23)(B), prohibiting the health plan
from restricting enrollee access to family planning services, and Minnesota
Statutes, section
62Q.14;
and
C. permit the commissioner to
terminate the contract upon 90 days notice to the health plan.
Subp. 3. Multiple health plan model areas.
After the department has executed contracts with health plans to provide covered health services in a multiple health plan model area, the department or an entity under contract with the department shall:
A. inform applicants and enrollees, in
writing, of available health plans, when written notice of health plan
selection must be submitted to the department, and when health plan
participation begins;
B. randomly
assign to a health plan enrollees who fail to notify the department in writing
of their health plan choice; and
C.
notify enrollees, in writing, of their assigned health plan before the
effective date of the enrollee's health plan participation.
Subp. 4. Single health plan model areas.
After the department has executed a contract with a health plan to provide covered health services as the sole health plan in a geographic area:
A. the department shall assure
that applicants and enrollees are informed, in writing, of participating
providers in the health plan and when health plan participation
begins;
B. the health plan may
require the enrollee to select a primary care provider and may assign to a
primary care provider enrollees who fail to notify the health plan of their
selection; and
C. the health plan
shall notify enrollees, in writing, of their assigned providers before the
effective date of health plan participation.
Subp. 5. Changing health plans or primary care providers.
A. In multiple
health plan model areas, enrollees may change health plans once within the
first year the enrollee participates in a health plan. After the first year of
health plan participation, enrollees may change health plans during the annual
30-day open enrollment period. The department or entity under contract with the
department shall notify enrollees when the annual open enrollment period will
occur.
B. In single health plan
model areas, enrollees may change primary care providers at least once during
the first year of health plan participation. After the first year of health
plan participation, enrollees may change primary care providers at least
annually. The health plan shall notify enrollees of this change
option.
C. If a health plan's
contract with the department is terminated for any reason, enrollees in that
health plan shall select a new health plan and may change health plans or
primary care providers within the first 60 days of participation in the second
health plan.
D. Enrollees may
change health plans or primary care providers for cause as determined through
an appeal under part
9506.0070 and as provided in
subitems (1) and (2).
(1) In multiple health
plan model areas, enrollees may change health plans without a hearing if the
travel time from the enrollee's residence to the enrollee's primary care
provider is over 30 minutes or the enrollee's health plan was incorrectly
designated due to department error. Requests for change under this subitem must
be submitted to the department in writing. The department shall notify
enrollees whether the request is approved or denied within 30 days after
receipt of the written request.
(2)
In single health plan model areas, enrollees may change primary care provider
without a hearing if the travel time from the enrollee's residence to the
enrollee's primary care provider is over 30 minutes or the enrollee's primary
care provider was incorrectly designated due to health plan error. Requests for
change under this subitem must be submitted to the health plan in writing. The
health plan shall notify enrollees whether the request is approved or denied
within 30 days after receipt of the written request.
Subp. 6. Family participation in a health plan.
All family members enrolled in MinnesotaCare must receive health services from the same health plan.
Statutory Authority: MS s 256.9352; 256.9363; 256L.02; 256L.12
Disclaimer: These regulations may not be the most recent version. Minnesota may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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